Breast infections, bub sucking in air> unsolved problems!!!!

First off I fed my first baby for 13 months, and while painful for first 5 weeks (because of 'sensitive' nipples and a baby with a minute mouth) was fine afterwards.
I now have a 5 week old. I expected the pain and was ready for it- and boy have I had it. Been to the LC and was told I was doing everything right, but for whatever reason that they couldn't figure out, he keeps sucking in air (I can hear the high pitch squeek noise) quite often. He does it more on one side than the other- which is weird. It means he goes on right, but feels like he slips off and grabs on again, but his mouth isn't as wide when he goes back on. Tried breaking him off every time he does it, but it means he gets frustrated, and doesn't end up drinking anything- any suggestions why he keeps coming off????? No, he doesn't have a tongue tie, and apparently I'm holding him right (LC and midwife said). have been told it's a mystery that they can't solve. Unfortunately it's very painful!!!
ALSO........
I have infections in my breasts that the dr doesn't know exactly what it is. They're extremely sensitive to the point of I really don't even want to wear clothes- the nipples feel like they're raw, but then I look at them and while they have cracks, there's nothing else there. The cracks are just not healing though, which is annoying. The whole breast feel hot, I can feel an infection or whatever through to my armpits sometimes. I was diagnosed with mastitis originally, took meds for it, cleared up, but came back with other symptoms like the extreme nipple sensitivity and shooting pains. I presumed it was thrush. I took diflucan 1-shot, and put on nipple antibacterial, while giving bub nilstat- didn't make any difference. Could it be something other than thrush??? I'm currently on flagyl as well, but I dont even know what for...

Please if anyone has any ideas or thoughts on any of this I'd be so grateful. Very close to giving up, which I so don't want to do!!!

Re: Breast infections, bub sucking in air> unsolved problems

Welcome to the forum! It sounds like you might have a variety of issues complicating your nursing experience with this baby. The first thing I'm wondering about is fast letdowns- babies who struggle with a rapid flow of milk often make funny noises while nursing, and often "slip up" onto or "clamp down" on the nipple. Do you ever see any of the following:
- Frequent feelings of engorgement or fullness
- Baby is satisfied after eating on just one side
- You're able to pump multiple oz of milk with ease, if you are pumping
- Baby coughs, gags, splutters, clicks, or clucks while nursing
- Baby pulls off the breast while nursing
- If baby pulls off the breast while nursing, you may see milk stream/squirt from the breast
- Baby's poops may be frequently green or greenish
- Baby gains weight rapidly

Can you describe the cracks you have? Are they small and slit-like, or are they single large wounds which gape wider after nursing?

What shape are your nipples after nursing? Symmetrical, like pencil erasers, or asymmetrical/creased/wedged/ridged/ shaped like new lipsticks?

Are you seeing any of the following:
- Dry, flaking, or peeling skin in the breast/nipple
- Nipples which appear red, very pink, or shiny
- Vaginal yeast infection
- Oral thrush or yeast diaper rash in the baby

I'm thinking that what you have is likely to be either thrush or mastitis, with a possibility that it's both.

Re: Breast infections, bub sucking in air> unsolved problems

greetings ellenbacher!
congratulations on the birth of your son. I was also frustrated at the amount of obstacles I experienced breastfeeding each new baby.
You have explored every usual resource for help and now you are turning to these forums for some brainstorming.
When I read your post what jumped out at me were the compounding factors contributing to your issues.
Mastitis and thrush, baby with an incomplete seal while nursing,( thus the air noise), cracked nipples and a toddler and infant to care for.
and still with all this piled on your plate, your impulse is to breastfeed.
Kudos. I would do the same,and here you have support from other mothers who "get it".
I will offer ideas that worked for me, so take what makes sense to you and whatever doesn't make sense, leave out.
1. check your bra. Is it all cotton with no underwire? is it made of a breathable material?
2. are you using disposable nursing pads w/ plastic backing? those things are a breeding ground for germs and yeast. Throw them out.
3. Expose your nipples to the heat and light from a lightbulb, 6 to 8 inches away for a minute or so.
4. No soap, lotion, powder, perfume, deodorant... clean your body with water only.
5. cut your nails and keep them clean from undernail gunk.
6. get your pets cleaned and groomed and off the bed. They spread yeast too.
7. nurse and/or express every two hours, keep your breasts comfortable soft. don't let them fill up with milk and don't leave a plug unclogged.
8. get in bed and stay in your pajamas with the baby. rest.
9. get your teeth cleaned and have any cavities filled.
10. do not use anti-bacterial soaps or hand sanitizers. old fashioned soap is ok to keep your hands clean .
11. sterilize your pump if your using one, boil the parts that can be boiled, same with any thing else that goes in baby's mouth, pacifiers, bottle teats etc...
12. If your other little one is in diapers check to be sure he doesn't have a thrush diaper rash.
13. have your husband check his feet for athlete's foot.

these are just suggestions. you probably have tried some of these tips already. Let us know how things are progressing.

Re: Breast infections, bub sucking in air> unsolved problems

Thanks so much for your replies. In response to mommall firstly, yes, I think I do have a fast let down (do often feel engorged/very full, he only eats from one side at a time, milk squirts out everywhere when he comes off), and I would think it's the problem but he didn't make the weird noise and slip off in the first 2 weeks- and also he makes the same noise when he's drinking from a bottle (expressed milk).
The cracks I have are small, but look like they're quite deep- surrounded by others that don't appear as deep.
The shape of the nipple is an easy way for me to know he's not on right, because they're not rounded- they're more ridged in some spots. I talked to the LC about it, and she said I was putting him on right- I can only think he's changing his 'grip' and getting less of a mouthful after losing suction. I tried breaking him off every time he did this, but often he's losing suction every 2 or 3 gulps- and after trying breaking him off so many times he just cannot grip on right.

I'm on my third round of penicillin for mastitis, and I took a one-shot diflucan which didn't do anything (I have a history of thrush, and think I'd need something stronger, but the dr wouldn't prescribe it).

Yes, I have vag thrush at the moment, and the nipples appear red with purple bits,and are shiny.

The most noticeable symptom I'm getting is extreme sensitivity of nipples all day every day, and then of course the pain during feeding- which might just be a latch issue- or not, I don't know!!! Because then what's causing the shooting pains within the breast???
Can't believe it's this hard!

Re: Breast infections, bub sucking in air> unsolved problems

Thanks for answering those questions. Based on your replies, I think you have a variety of issues going on right now. The first, and most obvious, is thrush. You have vaginal yeast, red, shiny nipples, multiple cracks per nipple, pain in between feedings, you've had several courses of penicillin (antibiotics kill off not only the bad bacteria that cause disease but also the good bacteria which keep yeast in check), and you've already been treated for thrush but your baby hasn't (when treating thrush in a nursing mom, it's vital to treat the baby, too, even if the baby is asymptomatic; otherwise the baby will reinfect mom after treatment is over). Honestly, I don't know that I've read a more textbook description of thrush! But it sounds like your doctor doesn't concur- which isn't surprising because a lot of docs only know to look for the one classic thrush symptom (white patches in the baby's mouth) and are unaware of how stubborn thrush can be, and that a single Diflucan shot may not be enough to fix the problem.

The first thing I would do would be to talk to the doc about your antibiotic. 3 courses of penicillin in 5 weeks... If the antibiotics haven't been able to beat the mastitis back for at least a little while, therers a good chance they are not effective against the type of bacteria you have. I think you should request a culture of your milk, to make sure you are taking the right antibiotic for the strain of bacteria you have. If one course of antibiotics frees you of mastitis, then you should have more freedom to deal with the yeast.

Dealing with thrush can be challenging. You will probably want medications for you and the baby- discuss your history and different options with your doc, don't let him walk out saying "Oh, I'll just give you Diflucan again, bye-bye!" You may need to see the pediatrician to get meds for the baby, and that's a good thing: pediatricians often have more experience with thrush than obstetricians do. While you're being treated for the yeast, you're going to want to tweak your diet. Reduce your intake of simple starches and sugars, and increase your intake of probiotics (e.g. yogurt, OTC probiotic supplements). You're also going to want to practice rigorous hygiene. Change all your clothes and your towels daily, and wash them on hot. Adding a vinegar rinse to your wash may also help. Wash your hands frequently. If you are pumping, sterilize all your pumping equipment, and also any bottles or pacifiers you are giving to the baby. And if you're pumping, remember that the milk you are producing right now is probably full of yeast, so you're not necessarily going to want to feed it to the baby without freezing or scalding it.

Now, I wish that was all, but I think you have some additional issues going on. I'm thinking oversupply is part of the problem. You're frequently full/engorged, you've had mastitis several times (making too much milk increases the risk of getting mastitis), you're seeing milk squirt when baby pulls off the breast, and your baby eats from only one breast per feeding. It's not surprising that the latch issue you're having has only cropped up now- first of all, if your baby has oral thrush that could be causing him discomfort and resulting in a worse latch, and second, babies often learn how to control milk flow by breaking suction, so the air sucking noise- often described as a click or cluck- is often something that babies only develop after they have been nursing for a while. Try nursing in a reclined position; nursing reclined enlists gravity to slow milk flow and make nursing more comfortable for baby.

How much are you pumping right now? You definitely don't want to exacerbate the oversupply problem by pumping. However, since you also have mastitis, it may be important for you to do some pumping: fight mastitis first, oversupply second.

Re: Breast infections, bub sucking in air> unsolved problems

Thankyou for you reply again. The drama is still continuing with me, after a few drs I found one to prescribe fluconazole in a decent dosage size- so I'm on that now. It's weird, but one day I'll feel much better and then the next it'll be terrible again, and then ease up the day after- doesn't make sense to me. Have been taking fluconazole for 5 days now- so I don't know if it's working, or not. But today at least I feel a bit better! (hopefully tomorrow I will too!)
I've been treating bub with daktarin in his mouth- but it hasn't made a difference to how he's sucking. So I'm not sure if it is thrush that caused him to start sucking weirdly. Because of that the cracks are still very much there, and feeding is still painful. Because I (and a couple of LCs) can't fix the source of the problem which means the cracks won't heal, and infection is likely to reoccur (and I'm so tired from being in pain) I've decided to wean him. So, I'm replacing a feed every couple of days with a bottle. Today I'm not feeding him from the breast at all, just pumping (when he gets hungry I jump onto the pump and express some out and feed him) - hopefully this'll give the cracks a chance to heal. A question- the nipple and areola are very sensitive and it's still uncomfortable to have clothes or anything on them. I've kept up with the anti-fungal creams on my nipples, but haven't had any success- could it be something other than thrush? Can cracked nipples have such an effect maybe?
I'm not on anything for mastitis at the moment- the dr had cultures taken from my milk and nothing grew to indicate mastitis, but I think if I don't start feeling better constantly then the dr will try a different antibiotic for mastitis anyway.
So that's where I'm up to at the moment. I really appreciate your concern and advice! Thanks!

Re: Breast infections, bub sucking in air> unsolved problems

Badly cracked nipples are going to be painful under clothes. So there's not necessarily anything you're doing wrong to cause the pain.

It's interesting that the culture didn't grow anything suspicious. There are women who are treated inappropriately for mastitis when they actually have thrush, and vice versa. I don't think I would treat this like mastitis unless I was seeing some or all of the following symptoms of mastitis: fever, aches and pains, red streaks or patches on the skin on the breast, chills and flu-like feelings, and an area of the breast which is consistently plugged/ engorged and painful to the touch. But if you do choose to take an antibiotic, I think I would talk to the doc about taking something in a different family from what you've been taking, and about taking something more powerful than what you've had to date.

You mentioned that the baby is "sucking weirdly"- can you tell us a bit more about that? There are latch issues that can cause pain similar to thrush pain... The thing that springs to mind first is something called vasospasm, which is a sudden, painful constriction of the blood vessels. It is often caused by compression of the nipple due to a poor latch. It can cause severe post-feeding pain, particularly in the nipple, and is often identified by color change in the nipple. If you see your nipple blanch (turn white) or blanch and then turn bluish-purple before returning to a normal color, you may be experiencing vasospasms.

Re: Breast infections, bub sucking in air> unsolved problems

I've had thrush for a couple months (I won't get into the details, don't want to hog your post). I finally got the doctor to prescribe a week's worth of fluconazole orally -it was like you, it seemed to help some one day, then not so much the next for the first couple days. By the end of the first week, I was feeling much better, but the first day I didn't take it, symptoms were back. I got the doc to reorder it for another week, and that did the trick, so it might just be that you need to stay on it for longer. Dr. Newman says a full week after symptoms are gone. I was also having painful vasospasms due to the thrush, and they are mostly gone now (I still take Calcium/Magnesium and Vit B supplements to help with those, and notice a difference on the days I forget to take it). Something to think about anyway. But I agree with mommal, email Dr. Newman - he is great about getting back to you, and will even attach a couple chapters of his book.

Re: Breast infections, bub sucking in air> unsolved problems

Thanks- I still feel better today so that is a really good sign. Yes, my nipples are always white when bub comes off, and sometimes in the day when I'm not feeding or anything one will just turn white for nor apparent reason, so I think I will look into getting those supplements (it can't do any harm).
What I mean by 'sucking weirdly' is that he cannot maintain suction while feeding. Some feeds are worse than others, but it gets to the point sometimes that he's breaking suction every gulp and you hear a squeeking/high pitch noise that means he's not totally on right. He does the same thing drinking from the bottle. He didn't do that for the first 2 weeks or so- which is the mysterious part of it. So, he latches on great initially, then he loses suction and clamps down on the nipple- and every feed my nipples look ridged/pointed- which means he's not on right. But I have no idea how to fix it, and neither did 3 lactation consultants! A total mystery to me!

Re: Breast infections, bub sucking in air> unsolved problems

Thanks for explaining the "sucking weirdly" thing. The latch issue you describe could be the result of fast letdowns- sometimes babies will "clamp down" on the nipple or make their latch shallower in order to control a fast milk flow. It's like crimping a straw. It's often a learned behavior, which could explain why your baby didn't do it for the first 2 weeks of life. Do you currently have a lot of milk? Are you feeling full or engorged on a fairly frequent basis?

Another thing that could cause the latch issue you described would be a tongue tie. If the LCs or your baby's pediatrician didn't detect one, I still wouldn't rule it out- maybe see if you can get him looked at by a pediatric ENT or speech pathologist.